Craniomandibular status and function in patients with habitual snoring and obstructive sleep apnoea after nocturnal treatment with a mandibular advancement splint: a 2-year follow-up.
The aim of the investigation was to evaluate the status and function of the temporomandibular joint (TMJ) and masticatory system in patients with habitual snoring and obstructive apnoea after 2 years nocturnal treatment with a mandibular advancement splint. Thirty-two patients participated in the study, ranging from 43.0 to 79.8 years of age (mean 54.4 years, SD 8.78) at the start of treatment. All patients had been referred from the ENT department for treatment with a mandibular advancement splint. The acrylic splint advanced the mandible 50-70 per cent of maximal protrusion, opened 5 mm vertically, and was used 6-8 hours per night and 5-7 nights per week. Overjet, overbite, and molar relationship were measured on dental casts. The patients were asked to answer a questionnaire concerning symptoms of craniomandibular dysfunction (CMD). They were also clinically examined in a standardized manner, including registration of range of mandibular movements, TMJ sounds, pain on movement, and palpatory tenderness of the TMJ and the masticatory muscles. None of the patients showed more than five symptoms of dysfunction either at the start of or after 2 years of treatment. A decrease in the frequency of headache was found for nine of those 18 patients that reported headache (P = 0.004). A minor, but significant decrease in overjet and overbite was found and the molar relationship was also changed. It was concluded that 2 years' treatment with a mandibular advancement splint had no adverse effects on the craniomandibular status and function, but the observed occlusal changes requires further evaluation. (+info)
Prevalence of signs and symptoms of temporomandibular disorders in young Nigerian adults.
The objective of this study was to determine the prevalence of signs and symptoms of TMD in young Nigerian adults and to establish a baseline for comparison with other studies. It consisted of a cross-sectional study at Obafemi Awolowo University, Ile-Ife, Nigeria in 1997. The subjects consisted of 308 medical and dental students (207 males and 101 females) randomly selected from a Nigerian University. Their ages ranged from 17 to 32 years with a mean age of 23 +/- 3.0 years. They were assessed according to the criteria of Helkimo (1974). Whilst 26.3 per cent of the subjects reported mild symptoms (Ai I) of TMD, only 2.9 per cent reported severe symptoms (Ai II). Similarly, 46 per cent showed mild dysfunction signs (Di I), whilst 16.5 and 0.3 per cent exhibited moderate (Di II) and severe (Di III) signs of TMD, respectively. No significant relationships were found between sex, anamnestic index, and the clinical dysfunction index scores. However, there were low but significant correlations between ananmestic index scores (Ai) and the recorded signs (Di), as well as the clinical dysfunction scores (CDS). There is some evidence to show that signs and symptoms of TMD occur amongst Nigerians, although restricted lateral and protrusive mandibular movements contributed significantly to clinical dysfunction scores. This report contrasts with what is found in western societies regarding the low prevalence of TMJ pain. Refereed Scientific Paper (+info)
Headache as a manifestation of otolaryngologic disease.
Headache can be caused by a multitude of factors, but experienced physicians accustomed to treating patients with headache are adept at making an accurate diagnosis. Occasionally, however, a patient has an unusual presentation of headache or facial pain. In these cases, it can be difficult to classify the etiology of the headache despite the performance of a thorough physical examination and the acquisition of appropriate diagnostic tests. Awareness of some of the otolaryngologic diseases that can manifest as facial pain or headache may help the physician better diagnose and treat this complex problem. (+info)
Temporomandibular dysfunction in patients treated with orthodontics in combination with orthognathic surgery.
Fifty-two patients with malocclusions underwent orthodontic treatment in combination with orthognathic surgery involving a Le Fort I and/or sagittal split osteotomy. Approximately 5 years after surgery, the patients were examined for signs and symptoms of temporomandibular disorders (TMD). The frequencies were found to be low in comparison with epidemiological studies in this field. The aesthetic outcome and chewing ability were improved in most patients (about 80 per cent). Some of the patients had reported recurrent and daily headaches before treatment. At examination, only two patients had reported having a headache once or twice a week, while all the others suffered from headaches less often or had no headache at all. Eighty-three per cent of the patients reported that they would be prepared to undergo the orthodontic/surgical treatment again with their present knowledge of the procedure. This study shows that orthodontic/surgical treatment of malocclusions not only has a beneficial effect on the aesthetic appearance and chewing ability, but also results in an improvement in signs and symptoms of TMD, including headaches. (+info)
Visco-supplementation therapy in internal derangement of temporomandibular joint.
OBJECTIVE: To study if visco-supplementation therapy is useful to the internal derangement (ID) of temporomandibular joint (TMJ). METHODS: Sixty-three ID cases (69 TMJs) were studied by visco-supplementation therapy. The upper and/or lower articular cavities were irrigated with 5 ml normal saline and injected 0.3-1.0 ml 1% hyaluronate (HA) into articular cavity. If the symptoms of the disease still existed one week later, the therapy should be repeated for 1-2 times, once a week. The control group cases were injected 1 ml 2% lidocaine instead of HA. 8 other TMJs of 6 ID cases and 2 normal cadavers were studied with scanning electron microscopy (SEM) and light microscopy (LM). RESULTS: The visco-supplement therapy was useful to ID patients. The difference between the test group and control group had statistical significance (chi 2 = 6.6535, P < 0.01). SEM and LM showed that the condyle, disc and bilaminar region in ID were degenerated or destroyed. CONCLUSIONS: The friction between the articular surfaces in ID was increased and the bilaminar region could not retract the disc as in healthy TMJ. The visco-supplementation therapy can decrease the friction and resume the normal rheology of the diseased TMJs. (+info)
Temporo-mandibular joint disease in ankylosing spondylitis.
The occurrence of temporo-mandibular joint (TMJ) disease in ankylosing spondylitis is not widely recognized and its incidence is disputed. Seventy-nine patients attending two routine rheumatology clinics were therefore examined by dental surgeon and nine (11-5 per cent) were considered to have specific TMJ involvement. These patients were older than the remainder, and had more extensive spinal and peripheral joint disease. Symptoms were mild and the predominant clinical feature was restricted mouth opening, which could present considerable difficulties during emergency anaesthesia. Bilateral condylectomy was undertaken in one patient with some benefit. (+info)
The accuracy of sonography for evaluation of internal derangement of the temporomandibular joint in asymptomatic elementary school children: comparison with MR and CT.
BACKGROUND AND PURPOSE: In order to clarify the incidence and evolution of disk displacement in the temporomandibular joint (TMJ) in children, we performed a longitudinal analysis in 18 subjects. Some investigators have suggested that sonography can provide information about the articular disk position of the TMJ. The purpose of this study was to determine the diagnostic accuracy of sonography for revealing internal derangement of the TMJ in elementary school children compared with our standard of reference, MR imaging and helical CT. METHODS: Eighteen children were examined using both sonography and MR imaging or helical CT or both. The sonographically revealed distance between the articular capsule and the lateral surface of the mandibular condyle was measured and compared with that obtained by MR or helical CT scanning. RESULTS: Compared with our MR/CT standard of reference, sonography revealed a sensitivity of 83%, a specificity of 96%, and an accuracy of 92% for identifying disk displacement (defined as a distance of 4 mm or more between the articular capsule and the lateral surface of the mandibular condyle). CONCLUSION: Although sonography's sensitivity, specificity, and accuracy for the diagnosis of disk displacement were slightly inferior to those of MR or helical CT, we assert it is a useful imaging method for longitudinal investigations of a large group of elementary school children. Internal derangement of the TMJ should be suspected if sonography reveals a distance between the articular capsule and the lateral surface of the mandibular condyle of 4 mm or more. (+info)
Temporomandibular disorders in relation to craniofacial dimensions, head posture and bite force in children selected for orthodontic treatment.
The present study examined the associations between craniofacial dimensions, head posture, bite force, and symptoms and signs of temporomandibular disorders (TMD). The sample comprised 96 children (51F, 45M) aged 7-13 years, sequentially admitted for orthodontic treatment of malocclusions entailing health risks. Symptoms and signs of TMD were assessed by 37 variables describing the occurrence of headache and facial pain, clicking, jaw mobility, tenderness of muscles and joints, and the Helkimo Anamnestic and Dysfunction indices. Craniofacial dimensions (33 variables), and head and cervical posture (nine variables) were recorded from lateral cephalometric radiographs taken with the subject standing with the head in a standardized posture (mirror position). Dental arch widths were measured on plaster casts and bite force was measured at the first molars on each side by means of a pressure transducer. Associations were assessed by Spearman correlations and multiple stepwise logistic regression analyses. The magnitudes of the significant associations were generally low to moderate. On average, temporomandibular joint (TMJ) dysfunction was seen in connection with a marked forward inclination of the upper cervical spine and an increased craniocervical angulation, but no firm conclusion could be made regarding any particular craniofacial morphology in children with symptoms and signs of TMJ dysfunction. Muscle tenderness was associated with a 'long face' type of craniofacial morphology and a lower bite force. Headache was associated with a larger maxillary length and increased maxillary prognathism. A high score on Helkimo's Clinical Dysfunction Index was associated with smaller values of a number of vertical, horizontal, and transversal linear craniofacial dimensions and a lower bite force. (+info)